Healthcare Provider Details

I. General information

NPI: 1316537756
Provider Name (Legal Business Name): AMANDA JON MCNALLY YATABE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 RINEHART RD STE 100
LAKE MARY FL
32746-4885
US

IV. Provider business mailing address

755 RINEHART RD STE 100
LAKE MARY FL
32746-4885
US

V. Phone/Fax

Practice location:
  • Phone: 407-875-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11011170
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11011170
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPRN11011170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: